Clues that can help us provide more effective care for those with treatment resistant depression are urgently needed. Sidney Zisook and colleagues report an analysis of the data from a large study of veterans with chronic depression (VAST-D) and conclude that two clinical features can help predict likely response to medications changes for some patients who have failed at least one trial of an antidepressant.
Two features suggested specific next-step treatment selections:
- Age >65 years (augmentation with aripiprazole was more effective
than switch to bupropion)
- Severe mixed hypomanic symptoms (for which augmentation with aripiprazole and combination with bupropion were more effective than switch to bupropion).
Not surprisingly, remission was more likely for individuals who were employed, less severely and chronically depressed, less anxious, not experiencing complicated grief symptoms, did not experience childhood adversity, and had better quality of life and positive mental health.
This data adds to other hints that may be used to predict treatment response….